The Imperfect Offering

Dedication

To Nanny and Dada Bob

Table of Contents

Dedication

Acknowledgments

Prologue

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Chapter 25

Chapter 26

Chapter 27

Chapter 28

Chapter 29

Chapter 30

Chapter 31

Chapter 32

Chapter 33

Chapter 34

Chapter 35

Chapter 36

Chapter 37

Chapter 38

Chapter 39

Chapter 40

Chapter 41

Chapter 42

Chapter 43

Chapter 44

Chapter 45

About the Author

Acknowledgments

I would like to thank Erin McCarragher, Susan McCarragher, and Angela van Barneveld for their suggestions and encouragement, and W.H. Schroeder for his expert technical assistance. I’d also like to thank my editors, Susan Strecker, Kathy Tracy and Karen Grennan for their dedication and fine work, and my publisher, Lisa Akoury-Ross for her guidance and support. Finally, I’d like to thank HPH hospice for the privilege of providing hospice care for our patients. The experience has been, and continues to be, both inspirational and life affirming.

We’re all just walking each other home.

—Ram Dass

Prologue

Thomas looked directly into the eyes of the man sitting across from him in the coffee shop. Why are you telling me this?

The man glanced at the customers on either side of them, placed his elbows on the table, and leaned forward, his voice a harsh whisper. A hundred grand. That’s all I’m asking. It’s only fair.

Thomas’s face burned. He surged to his feet, upending his coffee cup, the chair screeching against the cement floor. I’m leaving now. I’m going to walk out of here and pretend this conversation never took place.

The man remained still. I wouldn’t advise—

Thomas dashed out of the café to his car. He slammed the door shut.

Bastard!

Taking a deep breath to ease his clenched jaw, he wiped the sweat off his face, leaned his head back, and shut his eyes.

This can’t be happening.

Three months earlier

Dr. Thomas Haydn left his home at nine o’clock on a cloudy, unseasonably cool August morning. He welcomed a break from the scalding heat typical of new England summers. He headed to a familiar residential community just outside of Cambridge to check in on a new patient, Grace Fournier. In his five years as a staff physician at care for Life hospice, many of his patients had lived in this middle-class neighborhood.

He pulled into the driveway of a large Victorian home hidden in the shadows of an enormous elm tree, its branches overhanging both the street and the front edge of the house. Before stepping out he briefly reviewed the information entered by the admission nurse:

Seventy-eight-year-old female, pancreatic cancer, metastasis to the liver and lung, poor functional status, pain poorly controlled. Patient resistant to medications.

After ringing the bell he heard shuffling steps approaching accompanied by the tap of a cane on a wood floor. The deadbolt moved, and the door slowly opened to reveal a tall, gaunt, pale man. Black-rimmed glasses rested on his thin nose. He wore a lavender cardigan over a white dress shirt open at the collar, a pair of light-grey dress pants, and slippers.

Thomas enjoyed creating a mini-biography of patients and family from first impressions and a handshake and then comparing them to more informed knowledge that came later. He was often correct in his general assumptions but found it amusing and instructive when his initial imaginings turned out to be less than accurate.

Hi, I’m Dr. Haydn with hospice.

Bob Fournier. he smiled pleasantly as his long, bony fingers wrapped around Thomas’s hand, squeezing it lightly as if he were handling a delicate instrument. Thomas wondered if he were a musician, a pianist perhaps.

Bob led him to a large living room overflowing with furniture, a visual cacophony of contemporary items and high-quality classic styles. My apologies for the mess. My daughter and her husband moved in several months ago after their house burned down from an electrical fire.

I’m sorry to hear that. I mean about the fire.

We don’t half mind. Susan is such a great help to us since Gracie got sick. I can do without her husband, but ... he shrugged.

Thomas smiled. I understand.

Gracie is awake but still in bed. I’ll see if I can get her up.

Thomas waved him off. Don’t bother. I can see her there if she’d prefer.

I’ll go ask her.

While waiting, Thomas peeked into the kitchen. Dirty dishes lay piled in the sink and covered the counter. An open box of cereal and empty bottle of orange juice sat abandoned on a small, glass kitchen table. He wondered about the daughter.

Bob reappeared. Come on in, Doctor. Gracie wants to remain in bed for a while longer if you don’t mind.

Not at all.

The bedroom was uncomfortably warm and smelled of old linens, old furniture, and a hint of urine. The dark-wood headboard of the queen-size bed was ornately carved on the top and sides.

Their first bedroom set?

Bob sat in a well-worn chair next to his wife’s side of the bed. Mrs. Fournier, faded with age, was propped against several small pillows. A thin, beige sheet pulled up to her neck hid a conspicuous bulge in her abdomen. She turned her head toward Thomas and attempted a smile, her mouth almost convincing if not for her eyes. She grimaced slightly as she held up her hand. He gently grasped the cool, thin fingers and guessed she weighed about 120 pounds. The lines in her face and hanging folds in her neck and upper arms indicated that she had probably lost considerable weight recently. Her slightly jaundiced eyes receded into their sockets.

Thomas smiled. Hi, Grace. I’m Dr. Haydn, the hospice doctor. I’m here to help you and your husband any way I can.

Despite his experience, Thomas still found himself having to fight off the more natural I’m pleased to meet you greeting. The word pleased somehow didn’t feel right. When he first began the work he stumbled over the greeting, sometimes awkwardly throwing in the cliché: I wish it were under better circumstances. Words did matter—a great deal—when talking to a person who was dying. Having practiced as a primary care physician for fifteen years, he was on occasion reminded of this, but it seemed so much more important in hospice.

He glanced at a straight-backed wooden chair in the corner. Mind if I pull up next to you?

Bob gestured with his cane and scooted over to make room. Please, Doctor, have a seat.

Thomas moved the chair and sat facing Grace. How do you feel?

She attempted another smile. How do I look?

You look tired.

She shrugged and turned to Bob. Have you offered this young man a coffee?

Thomas shook his head. No, thank you. Do you mind if I ask a few questions?

Grace sighed and pulled the sheet a little higher toward her neck. Well, then, what would you like to know?

I understand that you have pancreatic cancer.

That’s what they say.

When were you diagnosed?

Three months ago.

Did you see a cancer specialist?

Yes, I saw her.

What did she tell you?

Grace touched her belly with a sad smile. Doc, do you have any children?

A boy and a girl, both in college.

Her bittersweet smile deepened the sadness in her eyes. That’s nice. We have a daughter, Susan, about your age I’d say. I guess you’ll be meeting her. She’s at work now.

Bob mentioned her.

Forty-seven years ago I caressed my belly, just like I’m doing now. I’ll never forget that day, or rather that night, when my water broke. I was scared. We didn’t have a lot of money. Bobby was just breaking into the diamond business.

Bob shifted in his chair. Gracie, I’m sure the good doctor—

Well, everything worked out. I loved being a mother. She smiled again, this time unforced, beautiful. I guess you might say I’m having kind of a flashback. She gently smoothed the sheet over her swollen belly as her eyes filled with tears. I know it’s ridiculous, but I’m even having some of the same feelings I had back then: how am I going to manage? how am I going to cope? except it isn’t the same, is it? If only I were young and beautiful and pregnant again. She wiped her face with her palm. Where does the time go?

Thomas squeezed her hand. I wish I knew.

Bob sat still as a statue, his hands on his knees, looking out the window to their left.

Thomas gave Grace a moment then continued. I do have a few more questions, if I may.

I’m sorry, go ahead.

Were you offered chemotherapy?

I got a couple of treatments.

How did it go?

It made me sick. I started getting all this water in my belly. The doctor took another scan. She said the cancer had spread, was growing fast, and that the chemo probably wouldn’t give me any more time, so there wasn’t much point in continuing. So I stopped.

How do you feel?

I feel terrible. You know how you feel when you just wake up early in the morning after being up too late or not sleeping good, and you roll over and hit the snooze button, and you feel so tired that you’d give anything for just a little more sleep?

Sure.

Well, that’s how I feel all the time. Not so long ago, I used to jump out of bed like a jackrabbit in the morning.

How’s your appetite?

What appetite? Everything I eat tastes like a dirty diaper.

Have you lost any weight?

About twenty-five pounds since I got the happy news.

Thirty-three, Bob said, still looking out the window.

Have you tried any nutritional supplements?

She grimaced. You ever try that stuff?

Bob turned toward Thomas. We have a garage full of it, every brand and flavor known to man.

That’s okay; it’s not for everybody. Thomas looked at his file. How’s your mobility?

I hang on to the furniture a lot. This bathtub of water I’m carrying around ... I don’t know; I just have no energy.

I understand you’re having some pain?

My back. That’s what started all this. Just wish I had listened to myself.

What do you mean?

I had the pain for at least six months before I finally gave in. If only I’d gone in sooner.

Bob’s shoulders sagged. "Gracie, you heard what she said.

It wouldn’t have made a bit of difference."

Bobby, she was just being kind.

Thomas shook his head. No, I agree with her.

So you’re a nice guy too, huh?

I try to be, but I’m not just saying it. Unfortunately, by the time pancreatic cancer begins to cause pain, it’s almost always too late for a cure. Believe me, nothing you or your doctor could have done would have made much difference.

Bob squeezed Grace’s hand and exhaled a soft sigh. Thank you, Doctor.

Thomas stood and removed the stethoscope from around his neck. May I examine you?

As he gently palpated her belly, he glimpsed a photograph of a young, vibrant Grace on the dresser, displaying a mountain of wavy, reddish hair with lipstick to match, bright smile, and silky-smooth alabaster skin. He was about to mention the photo but caught himself.

Her medication list included hydrocodone. Grace, how many of these pain pills do you take in a twenty-four-hour period?

She rubbed her belly. I don’t know. About six to eight, I’d say.

Bob frowned. Closer to twelve, Doctor.

It sounds like your pain isn’t very well controlled. On a scale of one to ten, with ten being the worst, how bad would you say the pain is?

Grace looked up at the ceiling. I don’t know sometimes five, sometimes eight.

It looks like we’ll need to make some changes to get you more comfortable.

What about one great big pill, so I won’t need any more?

Bob sat back as if she’d punched him. Gracie!

She turned toward her husband. I’m sorry, Bobby. I was just trying to be funny.

Thomas made a mental note to speak with the social worker and spiritual counselor. Let’s get you comfortable. I think we should start you on a low dose of long-acting morphine.

Her eyes widened. "Morphine?

Don’t worry. It’s a little stronger than what you’re on now, but it’s still pretty mild. I’d also like to use a fast-acting version for breakthrough pain, if that’s okay.

It’s not going to make me feel stupid?

Well, any narcotic, including the one you’re on now, can cause some drowsiness, but by starting with a low dose, we can minimize it.

All right, so start me on it. Are you okay with that, Bobby?

Certainly. How often can we expect to see you, Doctor?

I’ll drop in as needed. he glanced down at Grace. Your nurse will see you several times a week and report back to me, so I’ll always know what’s going on. If you’d like, we’ll also send out a social worker, a home health aide to help with personal care, and a spiritual counselor.

I guess, Grace said.

Doctor, will Gracie— Bob grabbed the bedpost. Sorry. Just having one of my dizzy spells. Head swimming all over the place. It’ll pass. A moment later, he settled back into his chair. Will she still have to go to her other doctor?

She may, but—

If you don’t mind, Doc, could we leave that for the next visit? She lightly rubbed her belly in small circles. My back hurts, and I’m so very tired. I’d like to take a nap.

Sure, let’s talk about it the next time.

Bob led Thomas back to the living room. Numerous family photographs covered the wall separating the dining room from the kitchen. Thomas found Bob and Grace’s wedding portrait. Bob stood tall and lean at the bottom of a winding staircase, his arm around his new bride, her flowing white gown arranged in a perfect semi-circle in front of them.

Thomas gestured toward the photograph. What a great looking couple.

Bob gazed at the picture, his expression wistful. I can remember it like it was yesterday. May 10, 1958, right here in Boston. She’s a wonderful woman, Doctor. he paused. I guess you hear that all the time.

Not the way you just said it.

If you’ve ever got a couple of minutes to spare while she’s napping, anytime, just let me know. I’d love to sit down and tell you a little about her.

I will. I’d like that.

Thank you, Doctor, he said with a smile. I appreciate your kindness.

Thomas wondered if, as her condition worsened, they would ever get the chance to share those stories. He hoped so.

Heading for the front door, Thomas passed a line of awards and commendations having to do with the diamond industry displayed on the wall near a large bay window. He stopped to study them.

Impressive.

Bob’s smile vanished. I suppose.

It looks like you were quite accomplished in the business. What did you—

Thanks for your visit, Doctor. Bob opened the door. We look forward to seeing you again.

Thomas hesitated. Oh, sure. he shook Bob’s hand. I’ll see you soon.

As he stepped out, puzzled over Bob’s sudden change in demeanor, a vehicle pulled up and parked in front of the house. A stocky, middle-aged man with a round face, thinning dark hair, and a white mustache jumped out.

Thomas nodded in greeting as they passed in the driveway. Sorry if I took your spot.

The man stopped. Are you the hospice doctor?

Yes, I am.

I heard you were coming.

May I ask how you’re connected with—

I’m the son-in-law. Alex

Thomas extended his hand. I’m pleased to meet you, Alex.

Alex hesitated slightly before taking the hand. I didn’t think Grace was ready for you guys. Doesn’t she have to be, you know...?

No, not at all. We can help Grace and the family in lots of ways long before that.

Yeah, well, I want you to know she’s a great woman.

I agree.

As Thomas got into his car, his thoughts returned to Bob. What an odd response to a compliment. And then there was Alex. He seemed a little rough around the edges, perhaps even a little confrontational.

Families ...

Thomas drove off, heading for his next visit.

Thomas made his second visit to the Fournier residence later that week. A slender, middle-aged woman with short, blond hair and kind eyes answered the door. You must be the hospice doctor. I’m Susan, Grace’s daughter. Come on in.

Thanks. Nice to meet you.

She motioned him into the kitchen. Alex sat at the table, hunched over a laptop.

I believe you two have met? mom is in the shower with the home health aide. I think they’re almost done.

Hi, Alex. How are you?

I’m fine. he turned toward Susan. Is mom okay?

Yeah. Doc is just making a follow-up call. She pulled a bottle of water out of the fridge and handed it to Thomas. Here; you look thirsty. I’ll go check on mom. Please, have a seat.

Thanks.

He considered joining Alex at the table but instead wandered